Provider Demographics
NPI:1053875104
Name:SANTOS, IRIS GRISELDA (LCSW)
Entity type:Individual
Prefix:MS
First Name:IRIS
Middle Name:GRISELDA
Last Name:SANTOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6249 EDGEWATER DR # 1058
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-4739
Mailing Address - Country:US
Mailing Address - Phone:689-231-1235
Mailing Address - Fax:877-388-0384
Practice Address - Street 1:6249 EDGEWATER DR # 1058
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-4739
Practice Address - Country:US
Practice Address - Phone:321-438-5826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111169900Medicaid